Omicron BA 5 Dominates and We Should Be Concerned.

Already having overtaken the rest of the world weeks ago with new cases, the Omicron BA 5 variant has now also taken over as the dominant strain in the US,outpacing BA 4 by a significant degree. When looking at a scatter plot of the degree of difference between all the variants since the start of the pandemic and comparing them with the original form, BA 5 is way out there. Meaning, it is the most unique variant with the most mutations we have seen thus far. At least as its appearance is concerned. It seems to be the most infectious as well but may not, hopefully, cause the most disease severity.

Both the Omicron BA 4 and 5 variants are primarily different in how their spike protein has mutated. Just a reminder, this is the protein on the surface of the virus which attaches to the ACE-2 receptor on the surface of various cells in our bodies. Our noses, lungs, hearts, pancreases, brain… This specific degree of change in the spike protein is the main reason that it not only evades immune protection from the various vaccines out there which all generate antibodies to the spike protein only, but also surprisingly evades immune protection from previous infection which generates antibodies to various proteins on the viral surface. Even a recent Omicron infection is not protective with many documented cases of infection with an Omicron BA5 infection occuring only weeks after an Omicron BA 1.2 infection.

What is even more concerning is that a large, yet unpublished study, is showing that with repeat infections, the risks of long term side-effects, serious illness and need for hospitalization all go up significantly, in some cases doubling with each infection. Death rates have not yet seen a trend, but enough time has not passed to make that determination.

The rates of hospitalization are all on the rise all over Europe where BA 4 and 5 have been dominant for a while. In the US, the hospitalization rates are still stable and “relatively” low, but if past experience is to be expected, we will likely see and increase as well. The post July 4 long weekend effect may still surface in the upcoming weeks.

Although the vaccine provides little protection against infection with BA 5, it still provides protection from serious illness or hospitalization. That having been said, our vaccination strategy must change from a “whack-a-mole” approach of chasing variants to one of a more generalized vaccine, covering more than just the spike protein, and maybe even more than one coronavirus. We now will soon have an Omicron-specific vaccine, but it was 7 months in the making, and the variant it was generated against has come and gone. In addition, generating a variant-specific vaccine puts evolutionary pressure on the virus and other variants are more likely to develop.

Everyone also MUST acknowledge what we know for sure. This virus and the pandemic aren’t going anywhere. In addition, the healthier you are, the less likely you are to get infected, have a serious case of Covid, need hospitalization, have long-haul symptoms or even die from this virus. The #1 risk factor remains being overweight or obese and sadly, those numbers have climbed during the pandemic, not diminished.

A healthier, more robust innate immune system is much more valuable from both an infection and overall health standpoint than relying on boosting our adaptive immune system through vaccination or actual infection. As mild a case as many people have had, you still do not want to get this infection if you can avoid it. I continue to see more and more long-haul symptoms in both adults and kids. 

Although I still strongly support vaccination, it will not save us. We must get healthier and be more cautious (mask and distance when appropriate and stay home if your sick).

Get better sleep. That’s when our bodies systems, including our immune system, recuperate.

Exercise more. In addition to helping with weight, it boosts immune function not to mention mental wellbeing.

Eat more plants (yes, those eating a healthy plant-based diet fare have the lowest Covid infection levels and least severe disease). GO VEGAN. For you, the animals and the planet!

Make sure your vitamin D levels are good. If you don’t know, supplement with 3-5000 units a day. Although we call it a vitamin (something which evolved by the dairy industry’s false marketing claims decades ago), it’s actually a hormone and in addition to being important for bone health, it is important for healthy immune function as well.

Other supplements to consider include quercetin, vitamin c, melatonin, zinc.

Socialize. We are not hermits and need one another.

Stay safe and be well.

AC

Despite what people may think, this pandemic is not over, and there is the potential for things to get much worse before they get better.

Watching what is going on around us these days, one would think that nothing is going on. People going about their daily lives, with an occasional masked person, today looked upon as odd rather than the norm, as it had been for over 2 years. But this attitude of complacency is allowing this pandemic to continue to simmer.

Presently, we have just under 300 deaths a day from Covid in the US. It is significantly higher in other places around the world where the Ba 4 and 5 variants are more common. At the height of the Delta wave, we had about 10x that amount, but 300 deaths a day is still significant. It’s more than how many die from diabetes or Alzheimer’s complications every day, and it seems to have hit a plateau. It’s hard to have an accurate number of daily new infections since so many of them are going unreported and are not requiring hospitalization or doctors visits but in many places in the US, hospitalizations are on the rise. Why? Again, it is about the numbers. As I have said before, a small percentage of a big number is still a big number.

In my office, I am seeing more and more people who have had Covid recently, and not surprisingly, more and more people with long-haul Covid symptoms. Loss of smell and taste, distorted taste, brain fog, weird mouth symptoms, ringing…

Presently, the main variant in the US is the Omicron Ba 1.2 1.2 variant (that is not a typo, it is just 1.2 x 2). But, just like everywhere else in the world, the Ba 4 and 5 sub variants are on the rise. Ba4 and 5 represented 5 and 8% of new cases 2 weeks ago. This week, they represent 11 and 25% of new cases, a clear and significant jump.

Although it is not definitively clear if Ba 4 and 5 cause more or less significant disease than its predecessor, it is definitely more infectious and even more concerning, it evades previous immune protection from vaccination and infection to a much greater degree. Even if one had a recent infection with one of the previous Omicron variants, there appears to be little protection against 4 and 5. Recurrent infections are becoming more and more common, and in many cases, recurrent infections are more severe.

It also appears that prior vaccination or infection is providing less and less reduction in death rate with recurrent infections. Disease severity seems to be still reduced overall, but death rates are only slightly reduced. In one study from Minnesota, whereas full vaccination and boosting reduced death rates by as much as 20x compared with those unvaccinated with previous versions of SARS-Cov-2, the rates with Omicron are barely above 1.5x risk reduction of death.

Although I am still a vaccine advocate, vaccines are not a panacea and will not save us. We need to shift our mindset from eradicating this virus to dealing with it. But dealing with it does not mean ignoring it and hoping for the best. I think that dealing with this virus will be a combination of changes in human behavior, people getting healthier in order to deal with the disease better and improvement in therapeutics, including updated vaccines, antivirals as well as other treatment modalities.

We can hope for more therapeutics, but ultimately, we know what works. Proper masking, distancing and responsible social behavior. I’m not saying we need to isolate and be hermits, wear a mask while riding a bike or keep a wide berth of all people at all locations! But reasonable, situational decisions are imperative.

1. If you are sick (or had a positive test, even if asymptomatic), stay home. Don’t get anyone else sick. It’s just responsible behavior. Don’t rely on negative tests since there are many false negatives, especially with the new variants, and few false positives. I also do not subscribe to the 5 day isolation rule. It simply does not clear that quickly. If you do mingle with people before the 10 days, wear an N95 mask to protect them. Lastly, a negative COvid test may mean you don;t have COvid, but if you have symptoms which make you concerned enough to test, you probably have some other kind of viral infection, so stay home, hydrate, eat your fruits and veggies and be responsible.
2. Mask appropriately. Wear a good one (N or KN95, thick or multilayer cloth, surgical or double surgical). Wear it correctly. And wear it where it makes sense. A small grocery store in the morning with few people is probably safe. A Friday afternoon at Wegmans is a Sh&* Show! Wear a mask. Or choose better shopping times. Being at an open air restaurant is probably fine. Being on the beach is fine. Riding a bike is fine. Being on the Boardwalk, shoulder to shoulder with the sweaty, screaming masses, maybe skip that one! Lastly, a recent study of many thousands of people showed that masking on planes reduces infection rates. So if you travel, be smart.
3. Get healthy so you are resilient. Stop making excuses and eat better, eat less, move more, stress less, sleep better. Just do it already. It’s cute to say you put on the “Covid-19”, like the “Freshman 20”… but once again the most significant risk factor for getting Covid and having a worse outcome is being overweight.

If I don’t post again before next weekend, have a great July 4th. We don’t need to make America great again. It already is great. We just need to appreciate all that we have and be a little less selfish.

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Stay safe and be well.

AC